TY - JOUR
T1 - Islet transplantation improves vascular diabetic complications in patients with diabetes who underwent kidney transplantation
T2 - A comparison between kidney-pancreas and kidney-alone transplantation
AU - Fiorina, Paolo
AU - Folli, Franco
AU - Maffi, Paola
AU - Placidi, Claudia
AU - Venturini, Massimo
AU - Finzi, Giovanna
AU - Bertuzzi, Federico
AU - Davalli, Alberto
AU - D'Angelo, Armando
AU - Socci, Carlo
AU - Gremizzi, Chiara
AU - Orsenigo, Elena
AU - La Rosa, Stefano
AU - Ponzoni, Maurilio
AU - Cardillo, Massimo
AU - Scalamogna, Mario
AU - Del Maschio, Alessandro
AU - Capella, Carlo
AU - Di Carlo, Valerio
AU - Secchi, Antonio
PY - 2003/4/27
Y1 - 2003/4/27
N2 - Background. The aim of this study was to evaluate the effects of islet transplantation on patient survival and diabetic vascular complications. Methods. Thirty-seven type 1 uremic diabetic kidney transplant patients underwent islet transplantation (KI group). Uremic type 1 diabetic kidney-pancreas (KP group, n=162), kidney-alone (KD group, n=42) transplant patients, and uremic type 1 diabetic patients still on hemodialysis (HD+DM group, n=196) constituted the control groups for survival and endothelial morphology. Results. Patient survival was similar in the KI and KP groups and higher than in the HD+DM group (P<0.05). Patients experiencing long-term islet function (KI-successful [KI-s], n=24) showed a better survival (100%, 100%, and 90%) than those in the KI group who lost islet function (KI-unsuccessful [KI-u], n=13) (84%, 75%, and 45%) at 1, 4 and 7 years, respectively (P=0.02). The cardiovascular death rate for the KI group (18%) was similar to the KD group (19%) but lower when the KI-s group is considered alone (5%), and showed a cardiovascular death rate similar to the KP group (8%). The KI-s group showed a good metabolic profile, with reduction of exogenous insulin requirement and persistent C-peptide secretion, as compared with the KI-u group. The endothelial morphology was evaluated with a skin biopsy obtained in all groups. The KI-s and the KP groups demonstrated decreased signs of endothelial injury compared with the KI-u and HD+DM groups. The KI group showed a better atherothrombotic profile than the HD+DM group, with higher levels of natural anticoagulant protein. Conclusions. Successful islet transplantation improves survival, atherothrombotic profile, and endothelial morphology in uremic type 1 diabetic kidney transplant patients.
AB - Background. The aim of this study was to evaluate the effects of islet transplantation on patient survival and diabetic vascular complications. Methods. Thirty-seven type 1 uremic diabetic kidney transplant patients underwent islet transplantation (KI group). Uremic type 1 diabetic kidney-pancreas (KP group, n=162), kidney-alone (KD group, n=42) transplant patients, and uremic type 1 diabetic patients still on hemodialysis (HD+DM group, n=196) constituted the control groups for survival and endothelial morphology. Results. Patient survival was similar in the KI and KP groups and higher than in the HD+DM group (P<0.05). Patients experiencing long-term islet function (KI-successful [KI-s], n=24) showed a better survival (100%, 100%, and 90%) than those in the KI group who lost islet function (KI-unsuccessful [KI-u], n=13) (84%, 75%, and 45%) at 1, 4 and 7 years, respectively (P=0.02). The cardiovascular death rate for the KI group (18%) was similar to the KD group (19%) but lower when the KI-s group is considered alone (5%), and showed a cardiovascular death rate similar to the KP group (8%). The KI-s group showed a good metabolic profile, with reduction of exogenous insulin requirement and persistent C-peptide secretion, as compared with the KI-u group. The endothelial morphology was evaluated with a skin biopsy obtained in all groups. The KI-s and the KP groups demonstrated decreased signs of endothelial injury compared with the KI-u and HD+DM groups. The KI group showed a better atherothrombotic profile than the HD+DM group, with higher levels of natural anticoagulant protein. Conclusions. Successful islet transplantation improves survival, atherothrombotic profile, and endothelial morphology in uremic type 1 diabetic kidney transplant patients.
UR - http://www.scopus.com/inward/record.url?scp=0037469055&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0037469055&partnerID=8YFLogxK
U2 - 10.1097/01.TP.0000061788.32639.D9
DO - 10.1097/01.TP.0000061788.32639.D9
M3 - Article
C2 - 12717219
AN - SCOPUS:0037469055
VL - 75
SP - 1296
EP - 1301
JO - Transplantation
JF - Transplantation
SN - 0041-1337
IS - 8
ER -